HEALTHCARE PAYER ENTERPRISE ARCHITECT

Roles And Responsibilities

• Define and govern enterprise architecture strategy, standards, and roadmaps
• Develop current-state, target-state, and transformation architecture for payer systems
• Lead solution architecture across claims, enrollment, provider, care management, and digital platforms
• Drive cloud adoption, API-first architecture, microservices, and modernization initiatives
• Define AI architecture patterns, data strategies, and automation opportunities
• Ensure compliance with healthcare standards and regulations such as HIPAA, CMS, and NCQA
• Lead architecture governance, review boards, and collaboration across business and technology teams
• Provide strategic technology guidance to senior stakeholders

Required Skills & Experience

• 12+ years of IT experience with 5+ years in Enterprise/Solution Architecture
• Strong expertise in the U.S. Healthcare Payer domain
• Deep understanding of payer processes including claims, eligibility, benefits, provider workflows, care management, and utilization management
• Experience with TOGAF or equivalent Enterprise Architecture frameworks
• Strong knowledge of cloud platforms (AWS/Azure/GCP), APIs, microservices, data architecture, and integration patterns
• Experience with healthcare interoperability standards including HL7, FHIR, and EDI X12
• Experience with payer platforms, digital ecosystems, and modernization initiatives
• Experience with AI/ML/GenAI solutions, including utilization management, prior authorization, automation, and analytics use cases
• Strong communication, stakeholder management, and consulting skills